5.2.3. Chemotherapy-Associated NOA

In men treated with chemotherapy, SRR ranges from 37 to 60%, pregnancy rates 33–50%, and LBR 22–42% (Tables 3 and 4) [79,92,100]. Additional studies have been performed examining SRRs and ICSI outcomes, but men treated for malignancy (either with chemotherapy or radiation) are often pooled with men who have NOA due to other underlying etiologies. Therefore, the reported clinical outcomes may not be accurate for men with azoospermia solely secondary to chemotherapy or radiation treatment. One retrospective study of male cancer survivors found that following chemotherapy or radiation treatment, approximately 57% were azoospermic [120]. This percentage is higher than expected in a full cohort of men treated with chemotherapy, as it reflects a referral bias to an infertility center for selected cancer survivors. The CPR was 38.6% and the LBR was 30.5% after ICSI [120]. Overall, SRR and ICSI outcomes are generally favorable for men who have undergone treatment for malignancy. In testis cancer survivors, 3% (who received chemotherapy) and 6% (who received radiation therapy) remained azoospermic two years after therapy [121]. With increasingly aggressive chemotherapy treatment regimens, the rates of persistent azoospermia are higher [122]. However, fertility preservation prior to cancer treatment is still highly recommended as it is minimally invasive for men and can potentially portend less invasive treatments for the female partner [22].
